Provider Demographics
NPI:1538112701
Name:MESHAD, MICHAEL WALLACE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WALLACE
Last Name:MESHAD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:29653 ANCHOR CROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9594
Mailing Address - Country:US
Mailing Address - Phone:251-625-6896
Mailing Address - Fax:251-625-6897
Practice Address - Street 1:3719 DAUPHIN STREET
Practice Address - Street 2:5TH FLOOR
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1753
Practice Address - Country:US
Practice Address - Phone:251-625-6896
Practice Address - Fax:251-625-6897
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL7158207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL222887Medicaid
AL009941786Medicaid
AL009941787Medicaid
AL051513708Medicaid
ALP00377085OtherRAILROAD MEDICARE
AL009941788Medicaid